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Home My WebLink About13424-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certi[icate O[ Occupancy No. ZI4989 October 15, 86 Date ................................. 19... THIS CERTIFIES th t th b ilding A d d i t ion ' d lt~aatlt~nt~fPr~n~rfxr 4120 Breakwater Roa Mattituck~ N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 09 9 .Block 5 .Lot 5 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated September 4 19 84 pursuant to which Building Permit No. 13424Z dated .... .S.e.p. ~..e .m.b.e.r..............6' 19 .87. ,was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Addition to exis. ting 9.ne family dwe, lling. The certificate is issued to .. G u s t a v & R u t h a n n e B a r t r a ................... ..................... of the aforesaid building. Suffolk County Department of Health Approval .......................................... N772262 UNDERWRITERS CERTIFICATE NO .................................................. Rev. 1/8'1 FOB, M NO,. '~ TOWN OF $OUT~OLO BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL cOMPLETION OF THE WORK AUTHORIZED) N? 13424 Z Permission is hereby granted to: .... .?.L...a.....q....~~.....:~... ....... .~.~.~.....~.:~.:.....u..~..~:~ .... ~ fO ........... ~. .~.'~: ..... ~ ................ ot pmmise~ Iocoted ot ............................................................................................................................ County Tox M=p No. 1000 Section ....... ..~...~..,.¢~... Block ....... .~... ........ Lot No. Building Inspector. Building Insl:~ct~ Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOil CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted i ~ to the Building Inspec- tor with the following; for new buildings or new use: 1, Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic featu res. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S~9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4, Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of pzoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5,00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.C. $5.00 5 .Updated C.C. $15.00 $15.00 Date. ,~.~'~..'~.~...~.4 ~"~ ........ NewCons%ruction Old or Pre-existing Building Vacant Land oca on of Proper . ' ....... House No, Street Ham/et Owner or Owners of Property . .~.~; County Tax Map No. 1000 Section Block ......... Lot . Subdivision ................................. Filed Map No ........... Lot No .............. Health Dept. Approval ..../~. ,~. ................. Labor Dept. Approval ....~?..~. ................ Underwriters Approval .... ~T~.A .... .~..7. ,7...~.~.(~ 2~Planning Board Approval ........ : ............. Request for Temporarv Cert ficate .... .~..? ............. Final Certificate .. ?~.~..-%.., ............ Fee Submitted $...~.,.' .-~-.. .................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ..................... Rev. 1a-10-78 .co ~UREAU OF ELECTRICITY T.~. ~..^'~ ....... "' "~"~~1~1 the electrical equ~ment ~ ~scribed below and introduced b t~ applicant ~med on the a~ve application number in the premises o ~3,......, ~' ., . 1-~.F.C.I P~el~: 1-12ci~'. 125an~ (~st av Bartra , ~'//¢'~' 2~'7 }~ast t~eak~ater Raod / ~m~~~w~wr~w~w~~ ' ce t' icate must not be altered in any manner; return to the office~~~of the Board iCincorrect.~_lnspect~rs 7._~mav ~_~.._~be~ identified ....by_ their ~redentials.credentials COPY ~OE B~ILDING DEPAETME~T. THIS COPY OF 6ERTIFICA~E,~OST HOT BE A~TERED IH AHY ~,NHE~. FIELD ~NSPECTION COMMENTS FOUNDATION (~st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CtODE ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH'PLBG. FOUNDATION ZND [ ] INSULATION FRAMING [~I~NAL REMARKS: o./~/ DATE ~- INSPECT 7GS-180,2 BUILDING DEPT, INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] ~OUNDATION 2ND [ ] INSULATION' [p,]/FRAMING [ ] FINAL REMARKS: INSPECTOR 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ...........~..'~.-~.~. .~-., 19.~\.~. Approved. · .~. ~..Y~...~...[t .7 19~.q.. Permit No./..~..~ .~..~...~.. Received ........... ,19... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .................. , 19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, m~d other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, hgusing code, and regulations, and to admit authorized inspectors on premises and in building. . ....... t~,~'~~. for necessary inspect/io, las. · . .... (Signai~fre of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. - . ............ Name of owner of premises .. ~.~.J.~[~..~. · · '~..~. · .~ · .~n.-~. f.2'.~. ........................................... (as on the tax roi[or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No...]. ~ · .~. ?.7 .~.--~... ~ .~..~.~.~ Other Trade's License No ...................... 1. Location of land on which propos~cl work will be done ........... 'f '~x~c4 '~',-~w ~' '~ ...................... '. House Number Street Hamlet County Tax Map No. 1000 Section ........ ~.~ ....... Block ...~. ............ Lot ..... .~.. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) ~ 2.State existing use and occupancy of premises and intended use and occupanfy of proposed construction: a. Existing use and occupancy . . .~..~.'.~.....F~..?r.~. ! ~ ~ CD taJ'~ ~-/.-i ~ .~ b. Intended use and occupancy . ~'.~ .~? .~'.. f.o./..~'~..~..~.~. (.*~. ~ .t?,. 5 ?.../7.~.V../2~.~.~. ~'.. 5'.d..PT.. ,C~.~ .~--(L.'~.. 10. 11. 12. 13. 14. property lines. Give street and block interior or comer lot. Nature of work (check which applicable): New Building .......... 'Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) Estimated Cost ..... , .: ..... Fee .......................... ~ *" (to be paid on filing this application) If dwelling, number of dwelling Units ............... Number o.f. dwelling units on each floor ................ If garage, number of cars ... ~.~d...~...C--;~/-/~..~.../?~r~...~-~?~ .t ...:~. ................................. If business, commercial or mixe¢ occupancy, specify n_.~tur.~ an.d_e~tent of each t3,,pe of use/ ..................... Dimensions p~existing structures, if any: Front..~tl~.../.1~..~.. Rear . .~../.O..~... Depth...I~_~o ......... Danensmns of same structure w!th alteratxons oradditmns: Front ...... )~. '. ...... Rear.. ]. ~ ~. .......... Dimensions of entire new construction: Front .. ~?~. ......... Rear . .,~¢, ......... Depth . ~.~. .......... Height ............... Number of Stories ............... ~ ......................................... S~zeoflot: Front ...{~.C~.~...i ........... Rear ..{.~..~? .... Depth .~.7 . ..~...~.C,.. Zone Or use district in which promises are situated ... J .~..~.. ~. ?..~:~i.T') .~... ~ ............................... Does proposed construction violate any zoning law, ordinance or regulation: ... ~.~. .......................... Will lot be regraded .../,~I.O..: ................... Will excess fill be removed from premises: Yes X' No Name of Owner of premises .~d.~:T-.-.-.-.-.-.-.-.-.~M..' .~.'~..~..~..~Address .~..~?.~/* .z~?~. T-~..~r. ~ Phone No. ~.~. ~.-.~ ~ ~J.... Name of Architect .......... ! ................. Address ................... .............. r" Phone No.~..~7..~.V/.7../..,~... PLOT DIAGRAM Locate clearly and distinctly alii buildings, whether existing or proposed, and, indicate all set-back dimensions from 'number or description accord/rig to deed, and show street names and indicate whether STA~ OF NEW YORK, COUNTY OF ...... S.S ............................ , .................... being duly sworn, deposes ~d says that he is the applic~t (Name of individual sig~ ting contract) above named. He is the ..................... .................................................................. (Contractor, agent, corporate officer, etc.) of said owner or ownem, ~d is duly authored to perform or have perfomed the said work and to m~e and file ~s application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work w~l be perfomed in the m~n~r set forth ~ the application filed therewith. Sworn to before me this ............ ..... ........... Nota~Public, ...~..~.~~..Coun ~ ~L~C~'Sto~* o~ ~w Vo~ ': _. (S~gnature of appHc~t)